Methods for assessing cardiovascular disease risk in a UK black population

OBJECTIVE: To assess differences between cardiovascular disease (CVD) risk estimation methods when applied to a black UK population. DESIGN: Cross-sectional study. SETTING: 51 GP practices in Lambeth, south-east London. PATIENTS: 26,370 black and 52,288 white registered patients aged 40-74 years. MAIN OUTCOME MEASURES: 10-year CVD risk score estimates derived using Framingham, QRISK2, ASSIGN and ETHRISK algorithms. κ measures of agreement between risk scores and age-adjusted black/white mean risk ratios (RR) derived for each score. RESULTS: There was a moderate agreement between the various risk scores for the black population (pooled κ 0.59 (95% CI 0.57 to 0.61) for men and 0.42 (95% CI 0.39 to 0.46) for women). For the white population, agreement was significantly improved (pooled κ 0.74 (95% CI 0.73 to 0.76) for men and 0.51 (95% CI 0.49 to 0.54) for women). Except for QRISK2, each method consistently overpredicted the CVD risk for the black population in comparison with national (Health Survey for England) prevalence figures. QRISK2 estimates were the least divergent from national data, giving a black/white mean RR of 0.73 (95% CI 0.71 to 0.74) for men and 0.85 (95% CI 0.83 to 0.87) for women. CONCLUSIONS: The choice of risk estimation method does make a difference to estimates of CVD risk for black patients. The QRISK2 method, which incorporates ethnicity as a risk factor, appears to have the best fit with national data for this population.